Guarantor name and address
myEasyMatch Code - this is NEW. You will use this number to pay your bill online or include the number on your check if you mail payment.
Due date - bills are due 21 days from the initial statement.
Payment summary - shows your payment summary by entity.
Important information - highlights the types of charges that are included on the statement. In addition, you may see important messages from Carle here.
Pay this amount - total amount due that is the patient's responsibility.
Area to fill out when paying by credit card
Split up payment for different entities - please indicate here if you would like your payment to be split between entities.
Payment information - outlines the different ways to pay as well as important information if you need help paying your bill.
Entity - this will identify which facility provided services.
Date of service
Description of services - If you are the guarantor of your account, this will show your charges as well as those for dependents on your account.
Total patient balance due for the entity